We Are All Psychiatric Patients

At a recent medical meeting, I was seated next to a family physician who, after having spent most of the evening complaining about everyone, told me—in response to no particular question from me— “All psychiatrists are in need of treatment themselves!” I was caught off guard by his uncensored articulation of yet another criticism, but was reminded that he may not be too far off base from the way that many of our colleagues view our profession.

My response to this colleague, by the way, in a moment of uncensored barbed humor, was to say, “At least we got help!”—a reference to how my own residency program encouraged us to go through our own psychotherapy/analysis on the road to becoming psychotherapists.

The view of our profession portrayed in so many films shows us either seducing/sleeping with our patients or their families (“Mr. Jones,” “The Prince of Tides”); full of ourselves and our special knowledge (“What About Bob?”); responding with physical force in a heated moment in therapy (“Good Will Hunting,” though that was actually a psychologist); or in more extreme forms, even eating our patients (“The Silence of the Lambs”)!

The last modern film I’ve seen that portrayed an even-keeled, benevolent psychiatrist as therapist was Judd Hirsch’s portrayal in “Ordinary People” back in 1980.

Have you noticed that when you tell others about how you decided to enter psychiatry, they expect some heavy philosophical response or that you were dealing with some deep-seated problem that sent you searching for answers through psychiatry training? A family physician or surgeon would not get the same line of questioning.

Being the third psychiatrist in my immediate family (along with my brother and father), I could always just say I entered the “family business.” The talk around the Drake nightly dinner table was about psychosis, neurosis, hospital work, and ECT, and it was not unusual for my father to be interrupted by an emergency phone call.

It was not until early in college that I entered my own psychotherapy for the first time—with a psychiatrist who was kind, fatherly, and humorous, during some anxious and depressed years while in college. I certainly needed to mature emotionally. I re-engaged in psychotherapy during residency training, but this time with an analyst, whom I credit with helping me to finally get married at age 34.

During residency training, we could always use the excuse that we pursued our own psychotherapy experience to help with our own patients—certainly true—but I needed it for myself as well. Years later, I began studying Murray Bowen’s theory on family systems in postgraduate training in South Carolina and Washington, D.C., receiving “coaching” on work on myself in my own family. All of these experiences were helpful to me personally and professionally.

In talking with a friend, I am struck by how we associate people with what they do. The proctologist is caked in excrement, the garbage collector in dirt, the mortician in death. The psychiatrist is mired in all that we fear about ourselves and each other—that the inner recesses of our minds will show ourselves and others that we are crazy, phony, not who we tell ourselves and others we are.

Many of my patients are or have been psychotic. Others are physicians, medical students, or psychotherapists themselves, and others who are dealing with less than satisfying marriages, a lack of meaning in their work or personal relationships, or a desire to mature beyond the point where their symptoms arise in response to changes or challenges to the status quo.

I’m not sure that we can avoid being seen as “contaminated” by some of our patients—that is, that “it takes one to know one”—but in the end we are all psychiatric patients. I try to pass on to medical students that it is not “us versus them,” as using DSM-IV might lead us to believe, but that we have all sought help somewhere, sometime, from a psychiatrist, mental health professional, clergy member, family member, or friend. It is somehow part of what makes us human that we need to connect with another member of our species in times of suffering or pain.

I hope that as psychiatrists we can use our training to alleviate some of that suffering through the physician-patient relationship, as we pass on to our physician colleagues in other specialties that we as a group are neither less nor more “crazy” than the rest of medicine. We all need some help at different times in our lives.

A family therapist mentor once told me, “You will have the same problems as everybody else. I would just expect you to deal with them differently.” ▪